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Introduction: Retroperitoneal fibrosis (RPF) is a rare disease which can be primary (idiopathic) or secondary to drugs, tumors or infections. We are reporting the first case of RPF causing renal atrophy, renal artery stenosis and renovascular hypertension associated with SARS-CoV2. Method(s): A 37-year-old female nurse presented to her PCP with a new-onset of hypertension. She had recovered from severe SARS-CoV2 infection merely two months ago. Physical examination was remarkable for BP 170/110 mmHg, HR 88 beats/min, BMI of 31 alongside trace pitting edema. Initial lab data showed her creatinine to be 1.1mg/dl and ultrasound of her kidneys showed an atrophied right kidney with a size of 7.8 cm while the left kidney was 11.6 cm. An ultrasound KUB of that same time showed that the size of the right kidney was 10.4 cm and left 11.5 with normal renal parenchyma. She was started on amlodipine 10 mg and valsartan 160 mg per day. Two weeks later she was referred to a nephrologist when her creatinine was increased to 3.1 mg/dl. Renovascular hypertension secondary to right renal artery stenosis or thrombus was suspected. Autoimmune & hypercoagulable work up was negative. CT angiogram showed an ill-defined, poorly enhancing retroperitoneal soft tissue thickening draping the mid abdominal aorta, the origin of SMA, and bilateral renal arteries which terminated above the aortoiliac bifurcation. This, RPF, involved segment of 8.6 cm of the mid and lower abdominal aorta, causing moderate narrowing of proximal SMA, short segment narrowing of proximal left main and accessory renal artery, and diffuse long segmental narrowing of the right main renal artery. RPF encasement of right renal artery lead to poor right renal nephrogram and atrophic kidney. (Figure no A: Abdominal contrast-enhanced computed tomographic (CT) scan showing the encasement of the both renal arteries by the retroperitoneal fibrosis (RPF).Figure no B : Renal angiogram showing the renal artery stenosis on right side) Acute kidney injury (AKI) was initially thought to be due to angiotensin receptor blockade in the setting of bilateral renal artery stenosis. Valsartan was swapped for metoprolol and the serum creatinine levels decreased to 1.5 mg/dl in two weeks. Prednisone was started for RPF at a dose of 60 mg per day with a slow taper over 4 months. Over the next 8 weeks, creatinine became normal and blood pressure was controlled with amlodipine 2.5 mg/day. Subsequently at 4 months her creatinine was 1.0 mg/dl and she was off all anti-hypertensive drugs. A repeat CTA after 6 months showed that there was significant reduction in RPF. Atrophic right kidney was noted without any significant interval change. RPF, renal artery stenosis, renovascular hypertension and right renal atrophy was strongly suspected to be associated with SARS-Cov2 since none of these were identified prior to her suffering from SARS-CoV2. Result(s): [Formula presented] [Formula presented] Conclusion(s): To our knowledge, this is the first case of RPF associated with SARS-CoV-2 causing renovascular hypertension and renal atrophy. Local and systemic production of IL-6, TGF- beta and Th2 cytokines has been demonstrated in idiopathic RPF and pulmonary fibrosis due to SARS-CoV2. The presumptive pathogenesis could involve SARS-Cov2 induced release of IL-6 and other cytokines which can activate B cells and fibroblasts. No conflict of interestCopyright © 2023
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Objective: To determine the role of Methylprednisolone in managing COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Jan to Feb 2021. Methodology: This study was carried out at the Department of Medicine. Medical records of all moderate, severe and critical COVID-19 patients admitted and receiving Methylprednisolone were reviewed. Methylprednisolone was used in all patients at doses 0.-2 mg per kg. Results: A total of 200 cases were included. The most common presenting symptoms were cough (77.5%), fever (67.5%) and shortness of breath (63.5%). Most patients (85%) presented within the first week of their illness. One or more comorbidities were present in 75% of patients. Most common being hypertension in 70(35%) and diabetes mellitus in 63(31.5%). Complications seen in the study were Cytokine release storm 92(46%) and acute respiratory distress syndrome 44(22%). The median time for initiation of corticosteroid therapy was 4 hours (range 1-96 hours). Overall survival (OS) in the study was 83.5%. OS for patients with moderate, severe and critical diseases was 97.8%, 86.2% and 62%, respectively (p<0.001). Conclusion: Corticosteroids are useful in COVID-19-admitted patients and provide excellent survival outcomes. © 2022, Army Medical College. All rights reserved.
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The paper deals with numerical analysis of solutions for state variables of a CoVID-19 model in integer and fractional order. The solution analysis for the fractional order model is done by the new generalized Caputo-type fractional derivative and Predictor-Corrector methodology, and that for the integer order model is carried out by Multi-step Differential Transformation Method. We have performed sensitivity analysis of the basic reproduction number with the help of a normalized forward sensitivity index. The Arzelá-Ascoli theorem and Fixed point theorems with other important properties are used to establish a mathematical analysis of the existence and uniqueness criteria for the solution of the fractional order. The obtained outcomes are depicted with the help of diagrams, narrating the nature of the state variables. According to the results, the Predictor-Corrector methodology is favorably unequivocal for the fractional model and very simple in administration for the system of equations that are non-linear. The research done in this manuscript can assure the execution and relevance of the new generalized Caputo-type fractional operator for mathematical physics. © 2022 the Author(s), licensee AIMS Press.
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The primary aim of this empirical paper is to identify the antecedents of ridesharing intention in the `new normal' era. This study uses attitude, subjective norm, and perceived behavioral control as mediators and environmental concern as the independent variable. An online self-administered survey approach was used to collect data from ridesharing users who have received two doses of COVID-19 vaccines. IBM SPSS 23.0 and AMOS 23.0 were used to conduct the statistical analysis for the study. Results revealed that environmental concern has direct and indirect effects on ridesharing intention mediated through attitude, subjective norms, and perceived behavioral control. These relationships are negatively moderated by perceived health risk on COVID-19. The study also discusses theoretical and managerial implications based on the research results.
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As of November 2019, the worldwide COVID-19 outbreak has impacted every aspect of life, particularly educational programs at various institutions. Online ones across the world replaced on-campus educational activities. Consequently, starting in March 2020, all educational activities in Saudi Arabia were being conducted online. As lockdown due to COVID-19 in Saudi Arabia ended in August 2020, alternative teaching and assessment plan implanted from March to June 2020 was changed to on-campus laboratory sessions and exams while still maintaining online teaching for theory courses during the fall semester of the academic year 2020-21 (CLAB-CTP 6.1). The assessment plan was modified accordingly (CLAB-CTP 6.2). Detailed safety guidelines for students, faculty, and staff were developed under the directions of the ministry of education and ministry of health to avoid COVID-19 exposure (CLAB-CTP 6.3). It included proper schedules to allow only a small number of students at a time on-campus (10-12 students), thermal screening at college entry points, social distancing, mandatory use of masks, frequent sanitization of workplaces before and after use, etc. These measures are considerably helping in avoiding student, faculty, and staff exposure COVID-19 in the program, college, and the university. A survey was used for the effectiveness of online teaching and assessment plans to achieve student learning outcomes and student satisfaction about virtual teaching. Student course evaluation surveys showed that student satisfaction about delivery of the courses during the COVID-19 pandemic was not significantly different from previous academic years (Figures 1b-6b). Surveys specifically targeted about virtual teaching show students' satisfaction about various aspects of online teaching. To improve any deficiency in student psychomotor skills due to COVID-19 lockdown, risk assessment subcommittee organized a meeting to set up an action plan for further improvement in student psychomotor skills (CLAB-CTP3.1). Under COVID-19 lockdown, contingency teaching and assessment plans were effective with student learning outcomes in all learning domains. Students were overall satisfied with online teaching and assessment.
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The relationship between oil prices and metal prices has been extensively investigated. However, the tail risk, systemic risk and spillover risk of oil prices have not been investigated via extreme value theory (EVT). We use this novel approach to determine the tail risk of oil, precious metals, how much risk they pose to the financial system and to what extent a shock in oil prices spill over to other precious metals as well as from the financial system. We use long time series of daily data from 1st January 1987 to 31st December 2021 as long time series is required for the EVT. The data is based on the total return index (RI) of four precious metals including gold, platinum, palladium and silver. Our results show that the tail risk of these metals is lower during the crisis period except the Covid-19 pandemic crisis. Most importantly, gold is a safer asset due to the lowest tail risk among four precious metals, indicating the claim that gold is a precious asset to mitigate the returns during market downturns and acts as a ‘safe haven’. Moreover, we also find that extreme systemic risk (tail-β) for crude oil and selected precious metals reduces during crisis period. This is also recognising the fact that these commodities act as a prospective asset for portfolio diversification to hedge against financial assets' volatility. Finally, the spillover risk among crude oil and selected precious metals varies over time, especially during the crisis period and crude oil is an important stimulator of the spillover risk for precious metals. By using our findings, financial market investors can improve their investment planning to attain the maximum advantage of portfolio diversification. Financial managers can further apply these results in forecasting to estimate future global oil market trends for improving their hedging skills and portfolio performance.
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Ever since Coronavirus disease 2019 (COVID-19) has been declared a pandemic by World Health Organization (WHO) it has gradually become top cause of morbidity. Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) possesses the tendency to cause severe symptoms in patients with a weakened immune system. In the setting where a mother develops mild COVID-19 infection yet remains stable, responds to medical treatment and there is no fetal compromise;the pregnancy may be continued to term with close surveillance. What is important in the current scenario is that the patients of COVID-19 along with any other comorbidities or medical conditions are at more risk of having fatal disease then the ones with COVID-19 alone. The pregnancy is one physiological condition in which a patient can face drastic pathological complications with COVID-19 if not given the due care. © 2020, Biomedica. All Rights Reserved.
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The impact of Coronavirus (COVID-19) disease has been reported for different countries. Males are at high risk of death due to COVID-19 as compared to females. There is no data available for Pakistan, the South Asian region. We are therefore undertaking this analysis to determine the gender effect on the outcomes of COVID-19 in the South Asian nation of Pakistan. An online survey was performed across Pakistan (Punjab, Sindh, Khyber Pakhtunkhwa, Balochistan) and national figures from the Pakistani government. In total, N = 113 individuals were included (92 males and 21 females). The descriptive statistics, association tests, and Pie chart indicate that males are more impacted by COVID-19 as compared to females. The doctor’s response indicates that 81.4% of males and 18.6% females are COVID-19 effective in Pakistan. Information from Pakistani national government statistics indicates that the number of male cases are 78%. Therefore, from the entire studies, we can infer that COVID-19 attacks more on males rather than females in the South Asian nation Pakistan. However, more quantitative studies are recommended to measure the extent to which sex would result in COVID-19 outcomes among Pakistan’s South Asian countries. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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This paper makes an innovative contribution to the extant literature by analysing the determinants of economic stimulus packages implemented by governments in response to the COVID-19 pandemic. In particular, we explore whether stock market declines observed in many countries can predict the size of COVID-19 stimulus packages. Moreover, we explore whether a country's level of income can augment the underlying relationship between stock market declines and stimulus packages. The findings reveal that a larger stock market decline results in a larger stimulus package; however, this effect is only observed in countries that have an income level greater than the mean and/or median per capita gross domestic product (GDP). Moreover, our results show that monetary policy is more responsive to a stock market decline than fiscal policy. Thus, our results underscore the importance of international donor agencies such as the World Bank and International Monetary Fund (IMF) in supporting less affluent countries in coping with the adverse impacts of the COVID-19 pandemic on their economies.
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In this article, a non-linear mathematical model has been proposed by incorporating the influential non-medicinal prevention measures together with an optimal control strategy to minimize the intervention cost of COVID-19 outbreak in India. During the unavailability of prescribed vaccines or antivirals, the transmission of COVID-19 infection has triggered the human health catastrophe. In the model, the disease-free equilibrium point is globally asymptotically stable if R-0 < 1, whereas due to inefficacy of prevention measures the endemic equilibrium point becomes locally asymptotically stable for R-0 > 1. The sensitivity analysis has shown the impact of various parameters on the reproduction number. The numerical simulations indicate that if R-0 becomes greater than unity then the pandemic will be disastrous later. Adequate implementation of prevention measures, detection at its full intensity and timely hospitalization facilities can lead to the elimination of the COVID-19 pandemic from India.
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World has experienced a new potent challenge in the shape of Coronavirus disease 2019 (COVID-19). Rapid screening and detection of infected patients is important step in fighting against this disease, so that proper measures can be taken to stop it from further spreading. Majority of the countries who have been successful in controlling the disease, have done it through effective early detection. The same factor is very evident in the countries where COVID-19 has gone out of control that they were or are not successful in early detection of suspected patients. This paper presents an artificial intelligence-based approach to provide new screening approach to detect COVID-19 from X-ray images. More than thirty-five thousand local/international negative and positive corona X-ray images were obtained to train VGG-16 model. Proposed method has two classifiers, first classifier distinguishes between negative cases and other infected cases, second classifier identifies pneumonia and other infected cases. These other infected cases will be recognized as COVID-19. Experimental evaluation on different X-ray imaging were conducted where this method classified positive and negative cases very effectively. A comparative study with publicly available network such as COVID-NET is also carried out. Proposed method outperformed COVID-NET in all three major areas such as overall accuracy, sensitivity and specificity. Overall accuracy for our technique is 95.08%, while sensitivity and specificity values are 100% and 93.15% respectively, while overall accuracy, sensitivity, specificity values for COVID-NET are 52.36%, 86.79% and 27.39% respectively. © 2021 IEEE.
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Background: COVID-19 has affected both adults and children with variable presentations and disease severity. Children can present with mild symptoms of fever, cough and shortness of breath, and rapidly progress to severe pneumonia, requiring mechanical ventilation. This population includes children who are younger than one year and older adolescents who have an underlying comorbidity-specifically immunosuppression or prior cardio-respiratory infections. In this review, we discuss the determinants of severe disease among the paediatric patients- primarily asthma, immune-status, obesity and multisystem inflammatory syndrome in children (MIS-C). Asthma and underlying lung pathologies can be a strong predictor (~20% prevalence) for development of severe COVID-19 infection, irrespective of age. However, as compared to asthma, a higher mortality rate was reported in immune-compromised patients. With a weakened immune system, immunosuppressed individuals were 1.55 times and immunocompromised patients 3.29 times more vulnerable to developing severer COVID-19 disease. Similarly, evidence suggests that a BMI of greater than 35 kg/m2 renders individuals more susceptible to developing COVID-19-related complications. This observation is based on the negative impacts obesity has on pulmonary functions and in downplaying the immune system. Furthermore, a possible association of COVID-19 and MIS-C has been reported by multiple studies across the globe but it needs further studies to strengthen its stance due to the scarcity of data when compared with the other determinants discussed in this article. Authors recommend researchers directing attention on synthesizing the evolving evidence to fill the knowledge void in the paediatric population, which will better enable paediatricians to make informed decisions.
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The new COVID-19 pandemic has spread to almost every nation in the world. Most of the available literature on the economic effects of COVID-19 focuses mainly on the recessionary effects of COVID-19 on different industries and aggregate economies. However, some industries, such as masks (surgical and N95, etc.), ventilators and miscellaneous medical services, benefit economically from the current COVID-19 disaster. More and more resources have been diverted to these industries due to the increased demand of these special industries. Excessive demand from these special industries will eventually return to normal or, under special conditions, fall below their normal (usual) demand once the pandemic has ended. Which, in turn, will not only affect these special industries, but can also have an impact on the recovery of aggregate economies around the globe. The study presents a comprehensive model for the different phases of the short-term lifecycle of these special industries. Presentation of the working and economic backlash resulting from the eventual decline in demand of these industries may encourage world economic policymakers to look beyond the current disastrous situation and to devise the necessary monetary and fiscal policies for the future COVID-19 free era. Otherwise, it will be difficult for the economies recovering from COVID-19 pandemic to move back to normal functioning, because the additional resources (such as labor and capital) allocated to these special industries may be idle for some time, which may increase the burden and drag the recovering economies of the COVID-19 pandemic into a deeper recession even when the pandemic is over. © The Authors, published by EDP Sciences, 2021.
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In this paper, we have proposed a nonlinear mathematical model of different classes of individuals for coronavirus (COVID-19). The model incorporates the effect of transmission and treatment on the occurrence of new infections. For the model, the basic reproduction number (R0) has been computed. Corresponding to the threshold quantity (R0), the stability of endemic and disease-free equilibrium (DFE) points are determined. For 0 > 1, if the endemic equilibrium point exists, then it is locally asymptotically stable, whereas the DFE point is globally asymptotically stable for R0 < 1 which implies the eradication of the disease. The effects of various parameters on the spread of COVID-19 are discussed in the segment of sensitivity analysis. The model is numerically simulated to understand the effect of reproduction number on the transmission dynamics of the disease COVID-19. From the numerical simulations, it is concluded that if the reproduction number for the coronavirus disease is reduced below unity by decreasing the transmission rate and detecting more number of infectives, then the epidemic can be eradicated from the population. © 2021 World Scientific Publishing Company.
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SARS-CoV-2 can vary on a spectrum of an asymptomatic disease process, to a severe stage characterized by a "Cytokine Storm". This phenomenon is a pro-inflammatory state marked by an intricate interplay of a cocktail of chemokines and cytokines. An excessively raised serum levels of cytokines and chemokines can lead to the development of acute respiratory distress syndrome. This article highlights the pathophysiologic mechanisms responsible for creating this cytokine havoc and delves into potential therapeutic interventions